Heart Health.... what really matters and the Lab test you need.

Annual physical blood work can often be very basic, and in our current healthcare environment we frequently need to self-advocate. One of the most important areas to monitor is heart health. Cardiovascular disease remains one of the most common causes of illness and death in the US — nearly 2,500 people die from it every single day. Our current treatments typically include medications like statins, beta-blockers, and calcium channel blockers, yet people are still dying from this disease at alarming rates. The decisions to start these medications are often based on blood work, but we frequently aren't testing comprehensively enough to make the best choices — whether that's a lifestyle change or a prescription.

What often triggers a cardiovascular event is what one of my teachers described as a "cardiovascular pimple" — a rupture that occurs inside or along the vessel wall. I want to share my favorite complete cardiovascular blood work panel:

1. Triglycerides – Research shows that triglyceride levels are often a better predictor of lifestyle choices than cholesterol alone, and they respond well to dietary changes. Excess calories are converted into triglycerides.

2. Lipid Panel – This measures your cholesterol levels:

   • LDL – Excess LDL cholesterol adheres to vessel walls and develops into plaques. Often called the "bad" cholesterol.

   • HDL – Often called the "good" cholesterol. HDL transports cholesterol back to the liver, helping to clear it from vessel walls.

   • Total Cholesterol – The overall amount of cholesterol in the bloodstream; a combination of LDL, HDL, and other lipid particles.

   • Non-HDL – All cholesterol particles other than HDL, including LDL and VLDL. As a general rule, the smaller the particles, the more likely they are to cause vessel damage.

3. Oxidized LDL (Ox-LDL) – A modified form of LDL that has undergone oxidative stress. It is toxic to the vessels and promotes plaque formation in the arteries.

4. Lipoprotein(a) – A genetically inherited form of harmful cholesterol. When elevated, it causes plaque buildup in the arteries and leads to restricted blood flow.

5. TMAO – A gut-derived metabolite produced during the digestion of choline, lecithin, and carnitine. It is a known biomarker for cardiovascular disease, atherosclerosis, and kidney dysfunction. High levels significantly increase the risk of stroke and heart attack.

6. Apolipoproteins:

   • ApoA – The primary protein found on the surface of HDL ("good") cholesterol particles. It helps move excess cholesterol from tissues back to the liver.

   • ApoB – The primary protein found on the surface of harmful particles like LDL and VLDL. Elevated ApoB is directly associated with plaque buildup.

7. Hs-CRP – A protein produced by the liver in response to inflammation. Chronically elevated levels significantly increase cardiovascular risk.

8. Homocysteine – A measure of amino acid breakdown in the blood. Elevated homocysteine is usually a sign that B6, B9 (folate), and B12 levels are too low to allow proper metabolism, and it is associated with increased cardiovascular risk.

9. Glucose – Measures the amount of sugar in the blood. Elevated glucose damages the heart by driving inflammation, worsening atherosclerosis, and forcing the heart to work harder.

10. Hemoglobin A1c (HbA1c) – Reflects average blood sugar levels over the previous 2–3 months and is the primary indicator for diabetes. Research has found that patients managing cholesterol often need to bring HbA1c down to the 5.3–5.4 range before they can effectively lower cholesterol — likely because of the underlying inflammation that elevated blood sugar causes.

Treatment for Abnormal Bloodwork:

1. Triglycerides – Dietary fat reduction, Niacin, Fish oil

2. Cholesterol – Niacin, Red Rice Yeast, CoQ10, Milk Thistle

3. Ox-LDL – Smoketree Extract, Grapeseed Extract, Tocopherols (Vitamin E), Pomegranate Fruit

4. Lipoprotein(a) – Niacin, CoQ10, Aged Garlic, Turmeric

5. TMAO – Berberine, Garlic, Turmeric, Fenugreek

6. ApoB – Diet, Exercise, Fish Oil, Reishi Mushroom

7. Hs-CRP – Diet, Exercise, Fish Oil, Turmeric

8. Homocysteine – B12, Folate, B6, B2

9. Glucose and HbA1c – Diet, Gymnema Extract, Cinnamon, Fenugreek, Holy Basil, Chromium

When it comes to taking any of these herbs and supplements, I've learned over the years that while social media and the internet can be useful starting points, a true functional medicine doctor or herbalist will help you reach a therapeutic dosage — which may be much higher than you'd expect. If you've tried something and felt it didn't work, it's worth revisiting whether you were actually taking enough. Dose matters.

Get these labs checked earlier than you think you need to. If your primary care physician won't run a full panel, consider seeking care from a functional medicine doctor, or order the tests yourself through a direct-to-patient lab portal at cash pricing — see the link below.

Link to our Direct-to-Patient Laboratory Portal: https://us.fullscript.com/j/ihc